关键词: 乙型肝炎病毒, 慢加急性肝衰竭, 血浆置换, 模型, 预后

Abstract: Objective To explore the value of serum prealbumin bilirubin score (PALBI) in evaluating the short-term prognosis of patients with hepatitis B virus-associated chronic acute liver failure (HBV-ACLF) treated with plasma exchanges (PE). Methods A total of 112 HBV-ACLF patients who received mutiple times (>3) of PE treatment were enrolled in this study. According to the clinical outcomes of patients, they were divided into two groups: a survival group and a death group. The difference of baseline characteristics between the two groups was analyzed and compared. The independent prognostic factors of patients post PE treatments were analyzed by multivariate analysis with an establishment of PALBI model. The differentiation of PALBI was evaluated by receiver operator characteristic curve (ROC) method. The model for end-stage liver disease model (MELD) and albumin-bilirubin (ALBI) scores of patients in each group were compared. Results Among the 112 cases of HBV-ACLF treated with PE, 77 cases survived and 35 cases died. Compared with the survival group, the proportion of patients with hepatic encephalopathy in the death group [15.58% vs. 48.57% (χ²=11.980, P=0.001)] and the advanced stages of liver failure disease [in the early stage 27.27% vs. 22.86%, in the middle stage 64.93% vs. 40%, in the advanced stages 7.80% vs. 37.14% (χ²=14.021, P=0.001)] was higher, the total bilirubin level was higher [364.07(287.05, 427.95) vs 456.16(351.20, 542.90) (Z=-3.810, P<0.001)], the prothrombin time was longer [22.61(18.40, 24.75), 26.58(21.40, 30.40) (Z=2.916, P=0.004)], and the prealbumin level was reduced [51.23 (37.50, 62.50), 37.14 (25.00, 52.00) (Z=3.212, P=0.001)]. Multivariate analysis showed that total bilirubin and prealbumin were independent influencing factors for the short-term poor prognosis of HBV-ACLF patients, The regression coefficient of total bilirubin was 0.011 (95%CI: 1.005~1.017; P<0.001), the regression coefficient of prealbumin was -0.064 (95CI%: 0.903~0.975; P=0.001), and the PALBI = 0.011×[TBIL (μmol/L)]-0.064×[PAB (mg/L)]-1.848. The area under the curve (AUC) of ROC for the PALBI model=0.827(95%CI:0.747~0.908, P<0.001), for MELD model=0.710 (95%CI: 0.604~0.815, P<0.001), for ALBI score=0.726 (95%CI:0.631~0.821, P<0.001), Pairwise comparison of ROC curve of PALBI and MELD (Z=2.470, P=0.014), and pairwise comparison of PALBI and ALBI (Z=2.274, P=0.023), shown that PALBI was better than ALBI score and MELD for predicting the prognosis of PE treatment (P<0.05). Conclusion PALBI has a certain clinical value in predicting the short-term prognosis of HBV-ACLF patients treated with plasma exchanges.

Key words: Hepatitis B virus, Acute-on-chronic liver failure, Plasma exchange, PALBI model, Prognosis